Document Detail

Long-term survival and functional results after aortic valve replacement in asymptomatic patients with chronic severe aortic regurgitation and left ventricular dysfunction.
MedLine Citation:
PMID:  15808758     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We examined the influence of medical treatment on the results of surgery in terms of long-term survival and functional results in patients with chronic, severe aortic regurgitation (AR). BACKGROUND: Asymptomatic patients with AR and a reduced left ventricular ejection fraction (LVEF) are at high risk because of a higher-than-expected long-term mortality. The influence of preoperative medical therapy on the outcome after aortic valve replacement (AVR) is not well known. METHODS: Surgery was indicated for the appearance of a reduced LVEF (<50%). At the time of AVR, there were 134 patients treated with nifedipine (group A), and 132 received no medication (group B). RESULTS: Operative mortality was similar in the two groups (0.75% vs. 0.76%, p = NS). The LVEF normalized in all of group A, whereas it remained abnormal in 36 group B patients (28%). At 10-year follow-up, LVEF persisted higher in group A (62 +/- 5% vs. 48 +/- 4%, p < 0.001). Five-year survival was similar in the two groups (94 +/- 2% vs. 94 +/- 3%, p = NS). Group A showed a 10-year survival not different from expected and significantly higher than that in group B (85 +/- 4% vs. 78 +/- 5%, p < 0.001), which had a worse survival than expected. CONCLUSIONS: Unloading treatment with nifedipine in AR allows one to indicate AVR at the appearance of a reduced LVEF with a low operative mortality and an optimal long-term outcome. The concept of surgical correction of AR indicated for reduced LVEF may not be applied to all patients. Indeed, in a large amount of untreated patients, a reduced LVEF preoperatively is not reversed by prompt surgery, indicating irreversible myocardial damage, and 10-year survival is worse than expected.
Roldano Scognamiglio; Christian Negut; Monica Palisi; Giuseppe Fasoli; Sergio Dalla-Volta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  45     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-05     Completed Date:  2005-04-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1025-30     Citation Subset:  AIM; IM    
Division of Cardiology, Department of Clinical and Experimental Medicine, University of Padua Medical School, via Giustiniani 2, I-35128 Padua, Italy.
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MeSH Terms
Aortic Valve Insufficiency / mortality*,  pathology,  physiopathology,  therapy*,  ultrasonography
Chronic Disease
Combined Modality Therapy
Drug Administration Schedule
Heart Valve Prosthesis Implantation*
Italy / epidemiology
Longitudinal Studies
Middle Aged
Nifedipine / administration & dosage*
Prospective Studies
Randomized Controlled Trials as Topic
Severity of Illness Index
Survival Analysis
Treatment Outcome
Vasodilator Agents / administration & dosage*
Ventricular Dysfunction, Left / mortality*,  pathology,  physiopathology,  therapy*,  ultrasonography
Reg. No./Substance:
0/Vasodilator Agents; 21829-25-4/Nifedipine
Comment In:
J Am Coll Cardiol. 2005 Apr 5;45(7):1031-3   [PMID:  15808759 ]

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